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- Title
Adaptation of the Risk Analysis Index for Frailty Assessment Using Diagnostic Codes.
- Authors
Dicpinigaitis, Alis J.; Khamzina, Yekaterina; Hall, Daniel E.; Nassereldine, Hasan; Kennedy, Jason; Seymour, Christopher W.; Schmidt, Meic; Reitz, Katherine M.; Bowers, Christian A.
- Abstract
This cohort study examines the utility of adapting the Risk Analysis Index for Frailty using diagnostic codes and whether the adapted version is associated with adverse outcomes. Key Points: Question: Can the Risk Analysis Index (RAI), a validated frailty assessment, be adapted to and validated in inpatient administrative data ubiquitously available in retrospective datasets and electronic health records? Findings: In this cohort study that included data from more than 9.5 million hospitalized adults, when the RAI parameters were adapted to the International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (RAI-ICD), increasing RAI-ICD scores were associated with an increase in hospital length of stay, hospital charges, and in-hospital mortality. Meaning: These findings suggest that the rigorously adapted, derived, and validated RAI-ICD extends the quantification of frailty to administrative inpatient hospitalization data. Importance: Frailty is associated with adverse outcomes after even minor physiologic stressors. The validated Risk Analysis Index (RAI) quantifies frailty; however, existing methods limit application to in-person interview (clinical RAI) and quality improvement datasets (administrative RAI). Objective: To expand the utility of the RAI utility to available International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) administrative data, using the National Inpatient Sample (NIS). Design, Setting, and Participants: RAI parameters were systematically adapted to ICD-10-CM codes (RAI-ICD) and were derived (NIS 2019) and validated (NIS 2020). The primary analysis included survey-weighed discharge data among adults undergoing major surgical procedures. Additional external validation occurred by including all operative and nonoperative hospitalizations in the NIS (2020) and in a multihospital health care system (UPMC, 2021-2022). Data analysis was conducted from January to May 2023. Exposures: RAI parameters and in-hospital mortality. Main Outcomes and Measures: The association of RAI parameters with in-hospital mortality was calculated and weighted using logistic regression, generating an integerized RAI-ICD score. After initial validation, thresholds defining categories of frailty were selected by a full complement of test statistics. Rates of elective admission, length of stay, hospital charges, and in-hospital mortality were compared across frailty categories. C statistics estimated model discrimination. Results: RAI-ICD parameters were weighted in the 9 548 206 patients who were hospitalized (mean [SE] age, 55.4 (0.1) years; 3 742 330 male [weighted percentage, 39.2%] and 5 804 431 female [weighted percentage, 60.8%]), modeling in-hospital mortality (2.1%; 95% CI, 2.1%-2.2%) with excellent derivation discrimination (C statistic, 0.810; 95% CI, 0.808-0.813). The 11 RAI-ICD parameters were adapted to 323 ICD-10-CM codes. The operative validation population of 8 113 950 patients (mean [SE] age, 54.4 (0.1) years; 3 148 273 male [weighted percentage, 38.8%] and 4 965 737 female [weighted percentage, 61.2%]; in-hospital mortality, 2.5% [95% CI, 2.4%-2.5%]) mirrored the derivation population. In validation, the weighted and integerized RAI-ICD yielded good to excellent discrimination in the NIS operative sample (C statistic, 0.784; 95% CI, 0.782-0.786), NIS operative and nonoperative sample (C statistic, 0.778; 95% CI, 0.777-0.779), and the UPMC operative and nonoperative sample (C statistic, 0.860; 95% CI, 0.857-0.862). Thresholds defining robust (RAI-ICD <27), normal (RAI-ICD, 27-35), frail (RAI-ICD, 36-45), and very frail (RAI-ICD >45) strata of frailty maximized precision (F1 = 0.33) and sensitivity and specificity (Matthews correlation coefficient = 0.26). Adverse outcomes increased with increasing frailty. Conclusion and Relevance: In this cohort study of hospitalized adults, the RAI-ICD was rigorously adapted, derived, and validated. These findings suggest that the RAI-ICD can extend the quantification of frailty to inpatient adult ICD-10-CM–coded patient care datasets.
- Subjects
RISK assessment; SECONDARY analysis; RESEARCH funding; FRAIL elderly; HOSPITAL care; LOGISTIC regression analysis; RESEARCH evaluation; HOSPITAL mortality; CONCEPTUAL structures; QUALITY assurance; LENGTH of stay in hospitals; DISCRIMINATION (Sociology); DATA analysis software; NOSOLOGY; MEDICAL care costs; SENSITIVITY &; specificity (Statistics)
- Publication
JAMA Network Open, 2024, Vol 7, Issue 5, pe2413166
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.13166